Individual
DR. ERIC MARK WIEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3911 AVENUE B, SUITE 1100, SCOTTSBLUFF, NE 69361-4617
(308) 630-2101
Mailing address
3911 AVENUE B, SUITE 1100, SCOTTSBLUFF, NE 69361-4617
(308) 630-2101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19880
NE
207RN0300X
Nephrology Physician
Primary
19880
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110111372
PALMENTO GBA RR MEDICARE
—
Enumeration date
08/04/2006
Last updated
04/20/2012
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